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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
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NCDs can be requested by external parties who identify an item or service as a potential benefit (or to prevent potential harm) to Medicare beneficiaries.External parties who may request an NCD are Medicare beneficiaries, manufacturers, providers, suppliers, medical professional associations, or health plans.
An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf.
Cook v. Gates, 528 F.3d 42 (1st Cir. 2008): "Don't ask, Don't tell" policy upheld against due process and equal protection Fifth Amendment challenges and a free speech challenge under the First Amendment. Glik v. Cunniffe, 655 F.3d 78 (1st Cir. 2011): First Amendment right to photograph public officials in a public place.
A court order is an official proclamation by a judge (or panel of judges) that defines the legal relationships between the parties to a hearing, a trial, an appeal or other court proceedings. [1] Such ruling requires or authorizes the carrying out of certain steps by one or more parties to a case.
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The appellate court cannot refuse to listen to the appeal. An appeal "by leave" or "permission" requires the appellant to obtain leave to appeal; in such a situation either or both of the lower court and the court may have the discretion to grant or refuse the appellant's demand to appeal the lower court's decision.
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